Dural tear with severe irrigation-related complications during unilateral biportal endoscopy under general anesthesia: a case series and literature review

Background: Unilateral biportal endoscopy (UBE) has been widely adopted in clinical practice owing to its advantages of providing a clearer surgical field, reducing estimated blood loss, and shortening hospitalization duration. Dural tear represents a common complication of UBE; when combined with the unique dual-channel continuous high-pressure irrigation system, it may trigger severe irrigation-related complications (IRC) that jeopardize patient safety. Case presentation: We retrospectively reviewed UBE procedures performed at the Fourth Affiliated Hospital of School of Medicine Zhejiang University from August 2024 to July 2025. A total of 5 cases of severe IRC following incidental dural tear of UBE were identified. Key clinical manifestations during the anesthesia emergence phase included refractory hypertension, tachycardia, postoperative emergence agitation, headache, and back pain. All patients achieved successful outcomes following comprehensive treatment. Conclusion: Incidental dural tear during UBE can result in severe IRC, which pose a considerable threat to patient safety. Comprehensive interventions-including sedation, analgesia, targeted management of hypertension and tachycardia, as well as administration of mannitol, furosemide, or methylprednisolone-are crucial. Anesthesiologists should maintain vigilance for these clinical features and proactively manage IRC associated with dural tear during UBE.